Cryptic Mucor infection leading to massive cerebral infarction at initiation of antileukemic chemotherapy

Abstract

A 74-year-old man with newly diagnosed acute myelogenous leukemia unexpectedly suffered a massive cerebral infarct on day 2 of induction chemotherapy. Clinically, the hemorrhagic infarct was thought to be due to leukostasis and thrombocytopenia. Necropsy, however, revealed that Zygomycetes-type hyphae had infiltrated cerebral vessels in and near the infarct. The fungal infection was clinically silent otherwise, although fungal elements were also identified in the lung at autopsy. This case illustrates how closely fungal infection may resemble a leukemia-associated cerebrovascular accident.

Subcortical Intracerebral Hemorrhage Caused by Mucormycosis in a Patient with a History of Bone-marrow Transplantation

“…1 Fatal cerebral infarctions caused by major artery occlusion by Mucor fungus were reported previously. [2][3][4] However, there have been only two case reports of ICH in patients with RCM. 1,8 In our case, we recognized occlusion of a cortical vein around the hematoma cavity.…”

“…1 It sometimes presented as a stroke. [2][3][4] We report a rare case of a patient with RCM who developed intracerebral hemorrhage (ICH) in the clinical course.…”

Cerebrovascular Disease in Acute Leukemia: A Clinicopathological Study of 14 Patients.

“…Agranulocytosis can induce fungal hyphae dissemination from the lung (pneumonia) to the brain, resulting in fungal emboli, instead of abscess (8) or granuloma (9) formation. Disseminated fungal infection often causes hemorrhagic infarction in neutropenic leukemia patients (2,7,8), although hemorrhagic infarction in leukemia patients could be diagnosed clinically as a result of abnormal coagulation ( 10). Fungal infection frequently complicates acute leukemia ( 1 1 ).…”

“…One patient (case 9) was treated with all-retinoic acid (ATRA), but had the pontine hemorrhage and subdural hematoma before the reduction of leukemic cells and resolution of DIC. Twocases (case 10 and ll) had relapsed acute promyelocytic leukemia, and had been treated with salvage chemotherapy. One case (case 9) was examined with MRimaging, which showed a concurrence of pontine hemorrhage and subdural hematoma.…”

Brain Zygomycosis in a Patient with High Risk Myelodysplastic Syndrome after Initiation of Chemotherapy

“…Zygomycosis manifests as a spectrum of diseases including stroke. [1][2][3] We present a case of disseminated zygomycosis with central nervous system (CNS) involvement in a patient with myelodysplastic syndrome (MDS) after initiation of chemotherapy.…”